Tuesday 28 January 2020

Waterford cardiac cath lab sought by Halligan would be 'wasteful of very limited resources'

University Hospital Waterford
University Hospital Waterford

Ralph Riegel

A confidential briefing note on Waterford Hospital, written days after the formation of the new government, warned a new cardiac laboratory would be “wasteful of very limited resources.”

Junior Minister John Halligan had sought a review of cardiac services at the hospital in return for supporting Enda Kenny as Taoiseach. However the briefing note prepared just days later said a second cath lab wanted by Mr Halligan could “potentially compromise patient safety.”

The Department of Health note formed part of a briefing document prepared for an independent medical expert asked to examine the case for a second catherisation lab for University Hospital Waterford (UHW).

Elements of the briefing note and terms of reference given for the review were initially redacted from releases over the past two months.

However Independent.ie  has seen the full briefing note which was written on May 27.

The minority Fine Gael Government, with the critical support of independents including Junior Minister Halligan, was formed just weeks earlier.

As part of his commitment to support Taoiseach Enda Kenny’s Government, Mr Halligan insisted he was promised a second cath lab for UHW.

But Health Minister Simon Harris maintained the clear understanding was the second lab would only be provided if its provision was endorsed by an independent clinical review.

The Government has now refused to fund the second lab because it was not supported by that review.

Mr Harris insisted that the review conducted by Belfast-based Prof Niall Herity was fully independent and totally free of political interference.

“You could not have got a more independent review than that of Prof Niall Herity. I have published that review in full,” Mr Harris said.

The Belfast expert recommended extra staff, equipment and opening hours for the UHW cardiac unit – but he did not endorse a second cath lab.

The May 27 briefing note, prepared by the department’s acute hospital policy unit, stressed that such a second cath lab was contrary to policy.

“In recent years there has been growing public and political pressure in the Waterford region to build and staff an additional cath lab at the hospital and to expand the existing service to a full 24/7 service,” it said.

“However, it has been the view of the department that providing additional facilities and extending services, in a geographical area which does not have the population base to justify such a service would be wasteful of very limited resources.”

“Such a unit might struggle to achieve the levels of activity essential to maintain operator and unit competency, potentially compromising patient safety. Staffing an extended service might also represent a challenge,” the briefing note warned.

In a statement, released on Sunday evening, Mr Halligan said he did not receive this full document until Saturday.

He said: "I have spoken to Minister for Health Simon Harris this evening and he has agreed to come to Waterford to listen to the views of local consultants and seek a way to move forward on the issue."

A spokesperson for Mr Harris told Independent.ie that the briefing note “accurately reflects the Department’s and the HSE’s position on the matter preceding the completion of Dr Herity's thorough and independent review which included broad consultation with a wide range of stakeholders”.

“The paragraph referred to was redacted on the decision of the FOI officer but was provided unredacted to Minister Halligan his on request,” she said.

UHW campaigner Kieran Hartley claimed the note was clear proof the Waterford hospital was never going to be given the promised second lab.

“Fine Gael could promise whatever they liked. But the Department of Health and the Health Service Executive (HSE) clearly never wanted a second cath lab in Waterford,” he said.

Mr Hartley said the determination to prevent UHW getting the second cath lab was borne out by the fact its catchment area was later understated from 520,000 to 280,000 and its critical cardiac risk rating was changed without UHW’s knowledge.

The risk rating, the most critical assessment of a hospital’s status, was changed from 20 out of 25 to 16 out of 25.

A Garda investigation into the risk rating change is now underway after a formal complaint was lodged by Mr Hartley.

The HSE rejected suggestions the key UHW risk rating was changed.

“The South South West Hospital Group (SSWHG) risk rating for the interventional cardiology services at UHW is 16. This rating has not changed in the past six months,” a HSE spokesperson said.

“Both the hospital and the group categorised this issue as high risk.

The difference between both relates only to a slight variation in how the impact associated with the risk is interpreted.”

One senior UHW consultant told the Independent.ie the latest revelations are “deeply worrying.”

Waterford has consistently maintained its development is being restricted so key resources can be focused on Dublin and Cork.

Critically, the briefing note also links cardiac services in Waterford with existing facilities in Cork.

“(The) 24/7 services for the SSWHG are currently provided from Cork University Hospital (CUH),” it said.

“That hospital has three cath labs and there are no issues in relation to the capacity of the hospital to meet demand (from Waterford and the south-east).”

However, another internal report revealed that 18 patients suffered heart attacks while on the cardiac waiting list at UHW over the past five years.

UHW doctors had expressed concern that waiting times for both inpatient and outpatient cardiac care had been steadily increasing since 2010.

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